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General NPI Number Information
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NPI Number | 1497863237
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Entity Type | Organization
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Legal Business Name | OPERATION HEALTHY SMILE INC
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 169 PLEASANT ST SUITE 204
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City | MARLBOROUGH
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State | MA
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Zip | 01752
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Country | US
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Telephone | 508-229-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 169 PLEASANT ST SUITE 204
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City | MARLBOROUGH
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State | MA
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Zip | 01752
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Country | US
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Telephone | 508-229-3131
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JOSEPH C PORAS
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Credential | DMD
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Telephone | 508-229-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4ZUU
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License Number State | MA
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